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AN 'AMINOGlYCO-GUIDE' FROM S.AFRICA

Recommendations on efficacy, safety and sensible use In a report to the Director of Hospital Services of the Cape Provincial Administration, S. Africa (and summarised in a recent South African Medical Journal), the efficacy and safety of the main aminoglycoside antibiotics are considered along with the factors involved in deve]opmentof mictobial reSistance. The main conclusions were:

• Gentamicin and tobramycin are essentially equal in efficacy, although some gentamicin-resistant Pseudomonas strains may be sensitive to tobramycin.

• When correctly admirustered, there is no practical clinical difference between them in ototoxicity or nephrotoxicity, though some animal tests suggest that tobramycin may be marginally safer.

• Improved safety can be achieved by limiting their use to hospitalised patients with serious disease, when broad spectrum drugs are unsatisfactory; by monitoring renal function (serum creatinine, urine protein and cells) and auditory function (tinnitus, hearing, vertigo) with regular audiography, ,in patients with renal iIllpairment or in those on the drug for more than a few days; by avoidance of other ototoxic I nephrotoxic drugs; and by careful adherence to recommended dosage schedules.

• Amikacin may be effective against organisms resistant to other aminoglycosides and it should be reserved for these resistant, severe. Gram-negative infections, except in institutions where such resistance may already be a major problem and a life-threatening infection requires immediate treatment before sensitivities are known.

• Both toxicity and the development of bacterial resistance c.-··be minimised by immediate discontinuation of topical or aerosol preparations, and discontinuation of neomycin bowel sterilisation.

Folb.I.P.: South African Medical Journal 55 : 807 (12 May 1979)

2 INPHARMA26 May 1979 0156-2703/79/0526-0002 $00.5010 ~ADIS Press